The emerging soft tissue paradigm in orthodontic diagnosis and treatment planning

TLDR

Orthodontic diagnosis has traditionally relied on hard‑tissue relationships and the Angle paradigm of ideal occlusion, but contemporary practice recognizes that soft tissues largely constrain treatment and that individual variation is the norm. The study aims to shift orthodontic diagnosis toward a soft‑tissue‑centric paradigm that prioritizes clinical assessment of soft‑tissue function and esthetics. The authors advocate for a diagnostic framework that incorporates detailed clinical evaluation of soft‑tissue function and esthetics, requiring new data collection and assessment protocols.

Abstract

Until now, orthodontic diagnosis and treatment planning has been based on hard tissue relationships and on the Angle paradigm that considers ideal dental occlusion 'nature's intended ideal form'. In this view, the clinician and nature are partners in seeking the ideal. In the modern biological model, variation is accepted as the natural form; ideal occlusion is the exception rather than the rule, and the orthodontist and nature are often adversaries. The orthodontist's task is to achieve the occlusal and facial outcomes that would most benefit that individual patient, whose esthetic concerns are often paramount. Because the soft tissues largely determine the limitations of orthodontic treatment, from the perspectives of function and stability, as well as esthetics, the orthodontist must plan treatment within the patient's limits of soft tissue adaptation and soft tissue contours. This emerging soft tissue paradigm in diagnosis and treatment planning places greater emphasis on clinical examination of soft tissue function and esthetics than has previously been the case, and new information in these areas is required.